“100% health” allows policyholders to access a range of care and equipment in the optics, audiology and dental sectors fully reimbursed by health insurance and complementary health insurance.
100% health aims to improve access to healthcare in these three areas.
Everything about 100% health at a glance (infographic)
What is 100% health?
In three sectors – optics, hearing aids and dental – “100% health baskets” are defined. They include a selection of treatments and equipment, the prices of which are capped and which are fully reimbursed after intervention by Health Insurance and your complementary health insurance.
What do the 3 100% healthy baskets contain?
Each basket is made up of a selection of quality care and equipment that meet the essential health needs of the insured:
- for the optical basket : a selection of lenses and frames;
- for the dental basket : a selection of bridges and crowns;
- And for the audiology basket : a selection of hearing aids.
In order to be able to be reimbursed in full for 100% health, you must therefore choose the care or equipment offered in these 3 baskets.
Who can benefit from 100% health?
To benefit from 100% health, you must have a “responsible” complementary health contract, whether individual or collective. Full reimbursement of care and equipment relating to 100% health is indeed an obligation of responsible contracts. From 1is January 2022, the third-party payment on 100% health will be systematically included in your complementary health contract: if the health professional accepts it, you will not have to pay any fees.
Does 100% health mean that all your expenses will be fully reimbursed?
The 100% health does not mean that all your health expenses will be fully reimbursed:
- in fact, 100% health only applies to the following 3 sectors: optics, dentistry and audiology. All your other health expenses (consultations, hospital treatment, medication, etc.) are not concerned;
- moreover, in optics, dentistry or audiology, only a selection of treatments and equipment is fully covered. In addition, apart from this selection, other treatments and equipment are not concerned with 100% health such as, for example, contact lenses, orthodontic treatments, dental implants or batteries of hearing aids.
It is therefore important that the guarantees and reimbursement levels of your complementary health contract correspond well to your needs beyond what is included in the 100% health baskets.
Depending on the guarantees in your contract, you can in fact also be fully reimbursed for care and equipment that is not included in the 100% health baskets. Your out-of-pocket expense can also be waived if you consult a healthcare professional who is part of your insurer’s partner network.
What are the obligations of opticians, dentists and hearing aids?
If you need glasses, dental prostheses or hearing aids, your healthcare professional must give you a quote with at least one offer falling under the 100% health basket (and therefore fully reimbursed if you have a “responsible” contract) . In dentistry, this information is only valid if there are therapeutic equivalents to the proposed procedures in the 100% health basket.
Opticians, dentists and hearing-aid acousticians also undertake to respect:
- the ceiling rates set by the regulations (your complementary health insurance cannot reimburse you beyond these ceilings);
- the deadlines for renewal of the equipment provided for by the regulations, namely at most every 2 years in optics (with exceptions) and every 4 years in audiology.
Do you have to choose “100% health” care or equipment?
You are completely free to choose the offer that best meets your needs and to opt for more sophisticated or innovative techniques or materials, within the 100% healthy baskets or outside these baskets:
- if you choose an offer from the 100% health care basket, your expenses will be fully reimbursed by your complementary responsible health contract;
- if you choose 100% health care and equipment excluding baskets, they will be reimbursed to you according to the guarantees provided in your contract. It is therefore important to be vigilant about the reimbursement levels of your contract.
In optics, you can choose part of your equipment in the 100% health basket and the other part outside 100% health. For example, you can take glasses from the 100% healthy basket and a non-basket 100% healthy frame. Your lenses will be reimbursed in full and your frames will be reimbursed according to the conditions provided for in your complementary health contract.
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